Executive Editor: Edward Ellis III, Kazuo Shimozato General Editor: Daniel Buchbinder

Authors: Carl-Peter Cornelius, Nils Gellrich, Søren Hillerup, Kenji Kusumoto, Warren Schubert, Stefano Fusetti, Coauthors: Enno-Ludwig Barth, Harald Essig

Midface

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Glossary

Horizontal lower lid laceration

Use of existing lacerations

Facial fractures are often associated with lacerations. These existing soft-tissue injuries can be used to access directly the facial bones for management of the fractures.

Approaches to the maxilla

Approaches to the maxilla

Relevant to the required exposure in trauma of the midface two different approaches are possible: the maxillary vestibular approach (illustrated) and the midfacial degloving approach.

Transcutaneous lower-eyelid approach

Lower eyelid - transcutaneous

There are three basic approaches through the external skin of the lower eyelid to give access to the inferior, lower medial, and lateral aspects of the orbital cavity: subciliary (A), subtarsal (B), and infraorbital (C) approaches.

Lower eyelid - transconjunctival

Transconjunctival lower-eyelid approaches are performed in several ways.

Glabellar approach

Glabellar approach

The glabellar approach can be particularly advantageous in elderly patients who have developed horizontal glabellar furrows due to the action of the procerus muscle.

Coronal approach

Coronal approach

The coronal or bitemporal incision is used to approach the anterior cranial vault, the forehead, and the upper and middle regions of the facial skeleton.

Not recommended

Not recommended

The ethmoidal approach is generally not recommended.

Superolateral orbital rim

There are two periorbital approaches to the superolateral rim of the orbit: the lateral eyebrow approach (supraorbital eyebrow approach) or the upper-eyelid approach.

Preauricular approach

Preauricular approach

The preauricular approach can be used to access and treat fractures in the mandibular condylar head and neck region.

Endonasal approaches (transfixion incision and intercartilaginous incisions)

Endonasal approaches

Endonasal approaches to the nasal skeleton can be used for primary treatment of traumatic injuries and for secondary procedures such as septorhinoplasty to correct posttraumatic secondary deformities.

External rhinoplasty approach (open)

External rhinoplasty approach

The external rhinoplasty approach to the nasal skeleton can be used for primary treatment of traumatic injuries and for secondary procedures such as septorhinoplasty to correct posttraumatic nasal deformities.

Extended glabellar approach

Extended glabellar approach

When wide visualization of the medial canthal area, lacrimal sac, and medial orbital wall is needed an extended glabellar approach is advantageous.

Zygomatic arch (indirect)

Common indirect approaches for reduction of the zygomatic arch include: the temporal (Gillies) approach and the transoral (Keen) approach.

v1.0 2009-12-03